Ectopic Pregnancy and COVID-19
You may have some questions about COVID-19 and how it may affect your ectopic pregnancy care. We hope the following will help to answer your questions; if not please do not hesitate to contact us.
Is there an increased risk of early pregnancy loss in relation to coronavirus?
According to the Royal College of Obstetricians and Gynaecologists (RCOG): “There is also no evidence to suggest that COVID-19 infection in early pregnancy increases the chance of a miscarriage."
I am experiencing symptoms of ectopic pregnancy. What should I do?
We are very sensitive of the fact that the coronavirus is creating intense challenges for the NHS and we understand that no one wants to overburden the health service at this difficult time. However, we ask anyone who is suffering symptoms of ectopic pregnancy to seek medical attention. If not diagnosed and treated quickly, ectopic pregnancy is a life-threatening condition and medical professionals will not think you are wasting their time for getting checked out so please do seek medical attention. Your health is important.
According to the RCOG: "Even during the pandemic, it is very important that if you have any questions or concerns about yourself or your baby at any time, you contact your GP, midwife or local early pregnancy unit straight away to discuss them. Some symptoms, such as pelvic pain, cramping and/or bleeding during early pregnancy, are linked to ectopic pregnancy and miscarriage and you should seek urgent medical advice should you experience any of these symptoms.
An appointment (either in person or via telephone) will be arranged for you as soon as possible with your local early pregnancy unit to check your symptoms. They will be able ensure you receive the care that you need."
When can I try to conceive again?
Trying to conceive can be a challenging time particularly after loss and especially in the current difficult circumstances.
Usually, women and couples are often advised by doctors to wait for at least two proper periods/three months before trying to conceive again to allow time for emotional and physical healing.
Women are advised to book an early scan when they are next pregnant with their Early Pregnancy Unit. This is to check that the embryo is in the right place and takes place at around 6 weeks’ gestation. However, in the current climate with coronavirus, the National Health Service is seeing a reduction in resources and capacity and there is the aim to minimise hospital attendance. In light of this, guidance by the RCOG states that for reassurance, an ultrasound scan would not routinely be offered and instead there would be a virtual consultation with an experienced healthcare professional. This means that if you are pregnant again after an ectopic pregnancy and do not have any symptoms, you may not be able to have an early reassurance scan in the current pandemic. It is worth speaking to your early pregnancy unit to find out.
There is no official guidance in the UK about trying for a baby at this time and whether to start trying to conceive is a personal choice. A key consideration is personal medical history particularly concerning an ectopic pregnancy and getting the care that she would need with any future pregnancy. The Association of Early Pregnancy Units suggests that women consider waiting until the pandemic is over before trying to conceive. This is to minimise the burden on the health service and to ensure people have full access to early pregnancy and maternity care. Ultimately, it is a woman/couple’s decision.
Do I need self isolate if I am receiving methotrexate treatment?
Methotrexate is an immunosuppressant when used for a long time to treat auto-immune diseases and skin conditions. The methotrexate regimen used for ectopic pregnancy is different; it is given in a maximum of two one-off doses to people with healthy immune systems and normal white cell counts. White blood cells fight infections. Very rarely, methotrexate causes the white cell count to fall and if this happens it could potentially impact their immune systems. In our medical advisers’ experience, this side effect is very rare and should neither prevent methotrexate being used, nor needing to routinely self isolate after having methotrexate.
According to the RCOG: It is likely the detrimental effects of methotrexate in COVID-19 are minimal in well women. Methotrexate is a mildly immunosuppressive medication but there is not thought to be a significant risk at the dose used to treat ectopic pregnancy. It is unlikely to increase vulnerability to COVID-19 and does not require home self isolation after administration.
I have been diagnosed with an ectopic pregnancy and am being treated expectantly (wait and watch) or medically (methotrexate) with multiple hospital visits scheduled.
It is important that you attend your hospital appointments as directed by your healthcare team.
Do I need to self isolate following surgical treatment for ectopic pregnancy?
We are not aware of any specific advice regarding self isolation following surgical treatment for ectopic pregnancy and all should follow the usual rules on social distancing.
I have had a previous ectopic pregnancy and am now pregnant again. Can I have an early scan?
According to the RCOG, for reassurance, an ultrasound scan would not routinely be offered and instead there would be a virtual consultation with an experienced healthcare professional. This means that if you are pregnant again after an ectopic pregnancy and do not have any symptoms, you may not be able to have an early reassurance scan in the current pandemic. It is worth speaking to your early pregnancy unit to find out.
I had methotrexate treatment, my levels have returned to non-pregnant, and have been offered the COVID-19 vaccine. Do I need to delay taking the vaccine?
According to doctors, the doses of methotrexate used to treat ectopic pregnancy are low and unlikely to result in low white blood cell count (white blood cells defend against infections) and so unlikely to cause issues with the vaccine. If you have any concerns, you could ask your doctors to carry out a blood test for a full blood count and check before being vaccinated. There are no studies/data about this and so it is impossible to give a definitive answer. However, the general view is that there is no reason to delay.
Key points from the RCOG:
It is important to know that if you experience any health issues during early pregnancy that require you to be seen by a healthcare professional, an appointment at an early pregnancy unit will be offered and you will receive the care you need.
Whilst hospitals are trying to minimize people entering in order to reduce the spread of the coronavirus and to limit the impact on services, they are organised in such a way that they are able to provide all acute services.
If you have symptoms that may be associated with miscarriage or ectopic pregnancy, it is very important that you contact your GP, midwife or local early pregnancy unit as soon as possible. You will be able to speak with an experienced healthcare professional on the telephone who will be best placed to advise you as to whether a visit to the hospital during the coronavirus pandemic is necessary and to ensure you receive the care that you need.
Guidance for surgeons working during the pandemic Royal College of Surgeons of England: 26 March 2020, as regularly updated
Coronavirus (COVID-19) NHS website